مجله پزشکی بالینی ابن سینا
سال بیست و پنجم شماره 1 (پیاپی 87، بهار 1397)

Warts are benign proliferations or mucosal tumors due to infection with various types of human papillomavirus that can affect the skin and mucous membranes. Some warts recover on their own without any effective treatments, but sometimes they need treatment because of pain and other problems, especially beauty issues. We aimed to compare the therapeutic effect of salicylic acid solution (40%) and cryotherapy for the treatment of skin warts.
This randomized clinical trial was carried out on patients presenting to clinics and Dermatology Department of Farshchian Hospital in Hamadan, Iran. All the patients were diagnosed with wart. Patients who met the inclusion criteria provided written informed consent. In each patient, one to three warts were randomly treated with cryotherapy and one to three others with salicylic acid solution (40%). After completion of the treatment period, we evaluated improvements and complications in the subjects. Then, the collected data were analyzed using SPSS software.
Overall, we studied 160 warts, which were randomly assigned to cryotherapy and salicylic acid solution (40%) groups (n=80 per group). Regarding the efficacy of treatment, the rates of non-healing, normal skin color, normal lines and both in the cryotherapy group were 6.2%, 27.6%, and 66.2%, respectively, and in the acid salicylic 40% group, these rates were 16.2%, 38.8%, and 42.0%, respectively (P=0.016). The incidence rates of pain, and blistering complications were significantly higher in the cryotherapy group than in the salicylic acid solution (40%) group (P The treatment of extra-genital warts with cryotherapy was more successful than treatment with salicylic acid solution (40%), and there were fewer cases of itching and hyperpigmentation in this group. However, pain and blister complications following cryotherapy were significantly higher than those in the salicylic acid solution (40%) group.

Intracerebral hemorrhage (ICH) is caused by bleeding within brain parenchyma and the formation of regional hematoma. In this study, we compared the effects of trinitroglycerin (TNG) and labetalol in controlling arterial hypertension in patients with ICH admitted to the intensive care unit (ICU) of Imam Hospital in Urmia city, Iran.
We selected 54 patients, 20 of whom were treated with labetalol (preferred treatment) and 34 received TNG serum infusion. Demographic information, disease severity (using ICH score, Acute Physiologic Assessment and Chronic Health Evaluation II [APACHEII] score, and Glasgow Coma Scale [GCS]), and the initial size of the hematoma (by computed tomography scan imaging) were recorded. Systolic and diastolic blood pressure were measured every one hour for 24 hours. The data were analyzed using the appropriate statistical tests in SPSS, version 20.
The mean GCS scores in the labetalol and TNG groups were 10.45±4.11 and 10.17±4.44, respectively (P=0.82). At the time of detection, the mean amount of hematoma in the labetalol group was 65.15±24.2 cc, and in TNG group, it was 63.16±28.1 cc (P=0.66). The mean reduction in the size of hematoma after 24 hours in the labetalol and TNG groups was 41.3±16 cc and 45±17.4 cc, respectively (P=0.95). Hypotension was observed in 10% of the labetalol group and in 17.4% of the TNG group (P=0.01). Changes in mean systolic and diastolic blood pressure were not significantly different between the two groups during 24 hours (P=0.83 and P=0.99, respectively).
Both drugs are effective in reducing blood pressure and no significant differences were observed between the two drugs in this regard.

Evidence is indicative of the positive effect of citicoline administration in stroke patients; however, there are controversies over this issue. Regarding this, the present study was conducted to investigate the efficacy of citicoline in acute stroke patients.
This randomized clinical trial was conducted on 160 patients with hemorrhagic and ischemic stroke. The participants were randomly assigned into two groups of intervention and control. The intervention group daily received 1 g citicoline injections for 10 days, in addition to the standard therapy. The baseline severity of the disease was determined by the National Institutes of Health Stroke Scale, and the outcome of the disease was assessed using the Modified Rankin Scale and Barthel Index on the 1st, 10th, and 90th days post-intervention. Statistical analysis was performed using Stata software (version 11.1). P-value less than 0.05 was considered statistically significant.
According to the results, there was no significant difference between the two groups in terms of gender, mean age, hypertension, diabetes, smoking, hyperlipidemia, and mortality after stroke (P>0.05). Regardless of the type of stroke, the severity of the disease decreased over time in both groups. However, at the end of the study (the 90th day), the intervention group had lower disease severity, compared to the control group (P Based on the findings of this study, the use of citincoline in acute stroke patients exerted no significant effect in the disease treatment in the short term. However, the long-term administration of this medication could result in significant impacts on the treatment of the patients, especially those with ischemic stroke, and improvement of their efficacy.

Pseudomonas aeroginosa is the most common pathogen associated with nosocomial infections and possesses virulence factors which contribute to the bacterial invasion and toxicity such as alginate, exoenzyme S, exotoxin A and elastase. The aim of this study was to determine the prevalence of algD, exoS, toxA and lasB genes in Pseudomonas aeruginosa samples isolated from patients by Multiplex PCR.
In this cross sectional study, sixty clinical samples were collected from Dey and Motahhari Hospitals, Tehran, Iran. Following identification of isolates by biochemical methods, Antibiogram test was performed using disc diffusion method with different antibiotics. Multiplex PCR method was performed to identify the desired genes.
37 out of 60 (61.66%) male and 23 out of 60 (38.34%) female specimens were positive for pseudomonas aeruginosa. The highest level of antibiotic resistance of the Pseudomonas aeroginosa isolates was observed against ceftriaxone (93.33%). The prevalence rate of virulence genes among all isolates was as follows; lasB (61.7%), toxA (60%), algD (43.3%) and exoS (5%).
Elastase, exotoxin A and alginate are considered important virulence factors of pseudomonas aeruginosa and they play a major role in causing diseases and tissue and skin lesions.

The knee is one of the largest joints in the body that, given its specific position, is directly exposed to blunt and posterior cruciate ligament avulsion. Considering the importance of this lesion, this study was conducted with the aim of investigating the results of posterior cruciate ligament (PCL) avulsion fixation in patients presenting to Besat Hospital of Hamadan, Iran, during 2013-2015.
In this descriptive cross-sectional study, 15 patients with acute knee injery symptoms treated with PCL fixation were studied. All the patients were operated by one surgeon. The following factors were considered in data analysis: demographic data, side of the injured knee, knee pain, lameness, swelling, posterior instability, locking, osteoarthritis changes, and mean Lysholm score.
This study was conducted on 13 (87%) male and 2 (13%) female patients with the mean ages of 27.2±4.3 and 24.5±0.5 years, respectively (P=0.526). Overall, 47% of the lesions were in the right knee and 53% in the left knee. After one year, we observed knee pain in 3 (20%), lameness in 5 (33%), swelling in 3 (20%), and posterior instability in 10 (67%) patients. Locking was not detected in any of the cases. Five patients (33%) were using a cane for a long time. The mean Lysholm score was 87.5. Outcome was good in six patients, satisfactory in four, and moderate in five patients.
One year after traumatic posterior cruciate ligament avulsion fixation, knee function was moderate to excellent.

Empirical antibiotic therapy of community- and hospital-acquired infections without the knowledge of the common causes and resistance patterns of the infections can lead to the enhancement of antibiotic resistance. Regarding this, the aim of this study was to determine the etiologic agents and antibiotic resistance pattern of community- and hospital-acquired infections.
This descriptive-analytical study was conducted on hospitalized patients with positive microbial cultures in two hospitals of Hamadan city, Iran, during 2012-2015. The participants were assigned into two groups of community- and hospital-acquired infections after their examination in terms of clinical manifestations. In addition to the common pathogens and their resistance patterns, the patients were examined for the type of interventions and underlying diseases. The data were analyzed in SPSS software (version 20) using the statistical tests.
Out of the 818 documented infections, 108 (13.2%) and 710 (86.8%) cases were community- and hospital-acquired infections, respectively. The majority of the positive cultures were respectively observed in the tracheal (62.7%), urinary (23.7%), and blood (9%) samples. Furthermore, the most frequent medical interventions included peripheral venous catheter (71.9%), suction (64.3%), ventilator (59.6%), and urinary catheter (16.5%). The most common etiologic agents of nosocomial infections were Escherichia coli (19.3%), Pseudomonas aeruginosa (18.9%), and Acinetobacter baumannii (16.6%). Regarding the community-acquired infections, the most common etiologic agents included E. coli (19.4%), coagulase-negative staphylococci (18.5%), and Pseudomonas aeruginosa (14.8%). The highest reported resistance among nosocomial infections was related to oxacillin and ciprofloxacin. On the other hand, community-acquired infection showed the highest resistance to vancomycin and ciprofloxacin.
As the findings indicated, Gram-negative bacteria are more common in both community- and hospital-acquired infections. In addition, the results were indicative of the enhancement of antibiotic resistance over time.

Car accidents are the second leading cause of mortality in Iran. For safe driving, drivers require minimum acceptable visual acuity. In Iran, the accepted routine test to take driving license is Snellen vision chart, which is not adequate for visual acuity determination in real and natural environment. It seems that introducing a more sensitive and specific screening test is necessary. In this survey, we studied whether adding contrast sensitivity test to the present screening protocol is valuable or not.
A cross-sectional study of 200 drivers presenting to the ophthalmologic clinic of Farshchian Hospital in Hamadan, Iran, was performed during 2014-2016. The participants were chosen using the census sampling method. Complete ophthalmologic examination, visual acuity evaluation, and contrast sensitivity test were carried out. Data were analyzed using SPSS, version 20.
The mean age of the participants was 39.6 years. The patients were allocated to a group with normal visual acuity and a normal corrected visual acuity group. The most common refractive errors were concurrent myopia and astigmatism. In normal visual acuity group, the percentages of abnormal contrast sensitivity (in increasing order of frequency) in appropriate lighting condition were 0, 8.3, 13.8, and 22.2 in the right eye and 0, 10.8, 16.21, and 18.91 in the left eye, and in reduced lighting condition, they were 0, 13.8, 33.3, 33.3, and 41.6 in the right eye and 0, 21.62, 21.62, 27.02, and 27.02 in the left eye. With normal corrected visual acuity, the percentages of abnormal contrast sensitivity test in normal lighting condition were 0, 14.28, 35.71, 64.28, and 64.28 in the right eye and 0, 7.69, 46.15, 53.84, and 84.61 in the left eye and 0, 50, 85.71, 92.85, and 92.85 and 0, 61.53, 76.92, 76.92, and 84.61, respectively, in low light condition.
It seems that contrast sensitivity test is a better predictor of visual ability in comparison with visual acuity, thus, it is recommended to be added to the vision-related driving license requirements.

Refeeding syndrome (RFS) is comprised of severe electrolyte disturbances and metabolic abnormalities that occur after the reinstitution of nutrition to starved patients.
This prospective study was conducted on patients aged over 18 years who were admitted to the Intensive Care Unit (ICU) of Taleghani and Emam hospitals in Urmia, Iran, during the first half of 2017. The included participants had the ICU stay of more than 48 h, were kept on nil per os, and were under nutritional support. The patients’ serum levels of phosphorus, magnesium, and potassium were measured on the 1st, 3rd, and 7th days of hospital stay. The frequency of RFS, hypophosphatemia, hypomagnesemia, hypokalemia, and the short-term outcomes of patients were obtained and compared. The patients with acute and chronic renal failure, cancer, previous gastrointestinal and hepatic diseases, and electrolyte disorder were excluded from the study.
The mean length of ICU stay and duration of mechanical ventilation were 35 and 28.5 days, respectively. The frequency of mortality among the patients was 36.96% (n=95). Furthermore, RFS, hypophosphatemia, hypokalemia, and hypomagnesemia had the frequencies of 13.23%, 25.7%, 21.4%, and 37.7%, respectively. There were significant differences between the patients with RFS and those without RFS in terms of the body mass index, duration of mechanical ventilation, ICU length of stay, and mortality (P In this study, despite the differences of our findings with those of the literature, the frequency of electrolyte disturbances during the onset of re-feeding was within an acceptable range.

Cardiac arrest during general anesthesia is a rare and potentially fatal condition. Despite the progression of monitoring equipments and anesthetic mediations, this phenomenon is still an important problem for the anesthesiologists.
Herein, we reported a 38-year-old opium addict plasterer male scheduled for laminectomy. He had no previous medical history and took no regular medication. Anesthesia was slowly induced with the intravenous administration of midazolam 2 mg, sufentanil 10 μg, sodium thiopental 300 mg, and atracurium 30 mg. The patient suddenly experienced respiratory distress, severe bradycardia, and cardiac arrest. Therefore, he was immediately subjected to cardiopulmonary resuscitation and intubation. Finally, the patient became hemodynamically stable and fully conscious and alert. He was extubated in operating room and transferred to the Coronary Care Unit. All laboratory tests were normal after cardiac arrest. Therefore, he was discharged in a good general condition. With regard to patient’s addiction and administration of atracorum and sodium thiopental, allergic reactions (anaphylaxis) seem to be the most likely cause of cardiac arrest during anesthesia.
This report emphasizes that anesthetists must always make sure of continuous monitoring and availability of resuscitation equipment and drugs. Moreover, they should be prepared to appropriately diagnose and manage sudden cardiac arrest during anesthesia.

The severe individual rotation is a kind of malposition of tooth that interferes with smile esthetics and may cause occlusal interferences.
A 13-year-old girl with 90° rotation of the right central maxillary incisor and lack of space was referred to Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran. Firstly, a spring-designed appliance was used between the left central and right lateral incisors to make enough space. Thereafter, a fixed orthodontic appliance was utilized to correct the rotation of the tooth.
The combination uses of fixed orthodontic and spring-designed appliances can successfully treat rotation of teeth.